Healthcare Provider Details

I. General information

NPI: 1578900320
Provider Name (Legal Business Name): ELIZABETH AITCHESON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 409
HARTFORD CT
06106-5523
US

IV. Provider business mailing address

85 SEYMOUR ST STE 409
HARTFORD CT
06106-5523
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-1588
  • Fax:
Mailing address:
  • Phone: 860-522-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125063165
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10836392-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number1066525
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: